Otho+B.+Will

From the //Peoria Medical Journal//, June, 1898

Original Communications THE BINKLEY CASE FROM A MEDICO LEGAL STANDPOINT

It seems to be due his professional confreres as well as him self that the writer present the actual facts at least in epitome of the now notorious above mentioned case at law Its merits have been exploited to a greater or less extent and with greater or less degree of truth in the metropolitan and local press and as it involves matters of the most vital interest to every practitioner of medicine its correct understsnding is a matter of grave concern

On April 19th proximo the writer who is attending gynecologist and obstetrician to the Cottage Hospital of this city was in the early morning urgently requested by the superintendent Miss Coolidge to call at once at the hospital. He reached the institution at about 9 am and was at once informed by the superintendent that a young woman had just presented herself and been admitted with a history of probably attempted abortion on the part of a notorious female physician of the city. Without waiting for any further particulars as gleaned by the superintendent the writer at once repaired to the patient's room in which a putrid odor was at once detected and found lying on the bed a woman about thirty five years of age engaged in vomiting at intervals of from three to five minutes an alternately yellow and dark green fluid almost pure bile rapid breathing a pulse of 130 to 140 per minute weak and restless mentally excited uncertain speech and bordering on collapse. From the bed arose a strongly putrid oder.

In the intervals of freedom from vomiting she was asked when this was done and she replied that she did not know as she (Dr Belle Howard) had been digging at her for a week. In reply to further questionings the patient stated that she did not ask her (Dr Howard) to do as she did but simply to give her medicine as she had missed before this and had come around all right from the use of medicine. The patient also explicitly stated that Dr Howard had told her after examination that she had a tumor and she would try and take it away if she would remain with her for some days. This she consented to do according to her statement and then reiterated her former remark that she (Dr Howard) had been digging at her every day of the time spent in her house and on Friday had nearly killed her. The patient had further according to her own statement told her friends at her boarding house that she spent or was going to spend the time in Chicago. The foregoing statement of the young woman secured between the attacks of vomiting was interspersed with lamentation to the effect that she had been driven and pushed from the Doctor's house and made to understand that she had to go notwithstanding the fact that she was weak and dizzy and scarcely able to stand or walk. She expressed a desire if she died to have the Dr Howard punished "for treating me so." She said she supposed that the Dr thought she was going to die and for that reason drove her out.

The writer told her in brief that whether she lived or died she should see to it that any one was punished who deserved it and that in view of the fact that she was likely not to get well she had better make an explicit statement regarding the case. This she declined to do begging to not have her condition made known to mother or friends unless she died.

Before taking any active measures in the case the patient was asked further whether Dr Howard had gotten anything away and she said she thought she had something in her hand at one time but could not tell what it was. The patient's condition evidently called for immediate attention and with the remark that what was done to save her must be done quickly the writer ordered the nurses to arrange the operating room at once supplying douches etc and without further parley the young woman was placed on the operating table given a hypodermic injection of strychnia and only lightly anesthetized in order to maintain circulation and at the same time admit of uterine dilatation without loss of expulsive effort. With the assistance of four nurses the vagina was retracted the closed though somewhat patulous uterus dilated with metalic dilator and the protrusion discovered of a soft putrid mass preceded and surrounded by a pus like discharge of sickening odor. By means of the placental and a couple of pairs of compression forceps the mass was removed small piece by piece being so soft and brittle as not to admit of any considerable portion being withdrawn at one time. Accompanied by hot sterilized douchings this was kept up for a considerable time perhaps an hour or over until there were evidences of fresh blood and the patient was rapidly weakening. I felt then obliged to desist and after a thorough douching of the uterus the patient was quickly put to bed given further injections of strychnia whiskey and milk and surrounded with bottles of hot water.

Daily douchings of sterilized hot water were ordered until possible reaction would take place and enable us to further cleanse the uterus. The patient however had evidently been saturated by the absorption of septic matter as she was already changed in complexion the right leg stiff and swollen from septic phlebitis the tongue hard and dry and urinary secretion suppressed. She became at once delirious would throw off the covers even get out of bed and attempt to escape by the window. A special nurse was detailed to watch her and after a couple of days the kidney secretion was largely restored the vomiting nearly ceased and the tongue became moister.

The patient had lucid intervals also and it was thought she might possibly recover. The leg however remained swollen and painful the peritoneum became involved notwithstanding the constant cleansing of the uterus under the hope that a helpful reaction would take place the pulse continued weak and fluttering in spite of stimulants the patient became more delirious sank into a comatose state and died on the eighth day.

During some of her apparently lucid intervals she was asked to make a statement regarding her relationship to Dr Howard but she absolutely refused begging that even her mother who had been for some days at her bedside be not made aware of her pregnancy. No effort however was made to conceal the real status after death and restriction in that respect during life was limited to inquirers outside the immediate family only. The woman's employer claiming to be her friend and her mother together with all the nurses and others knew fullv the circum stances of the case and the fact that no admonition of secrecy had been indulged in from any source.

The employer first and after her arrival the mother were taken into consultation respecting the best method of accomplishing the arrest and punishment if deserved of any responsible participants in the supposed criminal operation. The mother of the patient was the first to announce the fact of the latter's employer being held by her as having guilty knowledge of the case both before and after the woman's death. The allegation was also made by the mother that the daughter had in some way known only to herself induced a former abortion in the city of Cincinnati at which time and place she had demonstrated the existence of triplets. The mother's denunciation of her daughter's alleged seducer was bitter in the extreme she stating before witnesses that she proposed seeing justice done to him as well as the author of the unfortunate operation. She was told by the writer that he was more than willing to aid her with all the knowledge he possessed and upon her declaration to secure additional testimony which she claimed herself able to do it was arranged that the matter should in due time be brought before the grand jury and an attempt be made to get at the exact facts in all their relationships.

A conference of the writer with the hospital authorities involved the formulation at once of the facts in the case as presented in that institution for future reference and in expectation of the proposed action of those more immediately concerned In the meantime within the veek the coroner of the county a man noted for his officiousness was informed by some of the friends of the dead woman of the circumstances of the case and at once set about building up a claim that his prerogative had been ignored in the case and that an effort had been and was being made by both the hospital management and attendingphy sician as well as the paramour of the dead girl to conceal a crime and allow the guilty parties to escape punishment. He therefore immediately swore out a warrant for the arrest of the writer and the hospital superintendent as accessories after the fact of murder by concealment and that of the woman's paramour as an accessory both before and after the fact. The alleged real criminal however no attempt was made to arrest and she was permitted to walk out of towrn and secrete herself no one seems to know where as she has not yet been found although the indictment by the grand jury has presumably been in the hands of the proper officials ever since the adjournment of that body. The warrant was finally not served on the superintendent and her testimony as a witness was taken in which she told the prosecuting authorities that the writer was ready and willing to give them a clearer insight into the case than she could possibly do but they were pleased to ignore me entirely and finally through the grand jury brought in a true bill as against myself in accordance with the claims of concealment and also against the girl's alleged paramour for his double connection with the case In the meantime a commission consisting of the state's attorney and coroner and two local physicians had gone to the home of the deceased in Dublin Indiana where she was buried and held an autopsy with the result of verifying the certificate of death which the writer gave and which is on record and a copy of which was nailed on the coffin to the effect that the deceased an unmarried woman had died of ptierperal septicaemia.

At all events when one of the local newspapers telegraphed for immediate advice as to results the reply received from the local coroner as to the cause of death was "Same as given in death certificate." To most persons it woidd seem that the death certificate itself placed on record in the health office and on the casket of the dead would be sufficient nullification of the claim of concealment without anything further but the fact that no very definite statement could be secured from the dying woman and that no authoritative body had been refused knowledge of the case would seem to further justify the claim of not guilty to such a charge as made. Upon a motion before the circuit court to quash the indictment on account of a technical error in that the accused was not mentioned as having no family relationship to the alleged victim the State's Attorney in order not to further endanger his claim saw fit rather to nolle prosequi the case and immediately filed an information before the county court embodying substantially the same accusations but changed so as to harmonize with the technical requirements of the law. This transfer to the county instead of the circuit court of course eliminated the penitentiary feature of punishment in the event of possible conviction as no cases of so serious a grade can under the statutes of this State be tried in the inferior court. The case was consequently placed on the calendar for the 7th of June when a motion for continuance was made by the public prosecutor on the ground that he had been unable thus far to apprehend and try the principal in the case and that until he could do that any hearing of the minor cases would only jeopardize the result in all. The writer however as defendant insisted that the principles involved in his relationship to the pending controversy could have no especial bearing on the result of the verdict in the case of the principal accused. He claimed that he should not in justice be kept for an indefinite time under a shadow He was ready to have the case at any moment tried on its merits and that anything short of that would savor of a desire to persecute. Under such circumstances the trial judge could see no proper justification for continuance.

The prosecuting attorney expressed himself as unable to independently make out a case and that declaration was at once followed by the court's dismissal of the whole proceedings in so far as they pertained to to the actions of the writer. This summary dismissal was not altogether pleasing in that it was hoped in this case to get a judicial decision on the points involved that would prove of value as a guide to subsequent action of the profession along the line of duty to the public as well as the individual patient in this particular class of cases. However the writer is firmly convinced from incidental decisions and tacit admissions secured during the course of the foregoing case up to the time of its dismissal by the court that he would most likely have been sustained in his contention that it is no part of the duty of the physician to play detective for the authorities. That the physician who has seen and treated a case prior to death is under no special obligation to notify the coroner but on the contrary from his knowledge of the circumstances must be permitted to exercise his own judgment regarding his duty to the public. That in order to be justly considered an accessory after the fact of such a crime it must be proven that he took an active interest in concealing the same and shielding the criminal and that any statement of the patient is a dying statement within the law's intent only when the patient expresses herself as knowing that she is about to die.

We should be much pleased to hear from the readers of this JournaI of anything in the way of decisions by the courts of this state relative to the questions involved in the foregoing recitation which are of such great importance to the comfort and welfare of the profession. If it is the duty of the physician to have the aid of the coroner in making a diagnosis before death or after it when previously attendant on the case it is desirable to know it at once. If the coroner can rightfully expect of every physician a voluntary detailed statement of the circumstances in any case of disease or injury we as a professional body want to know it If under such circumstances as in the case at issue the physician must be denied the privilege of under oath stating his own position before the grand jury it is desirable yea absolutely necessary for our own and the public's protection to know that too.

OB W1ll MD